Healthcare Provider Details

I. General information

NPI: 1275810343
Provider Name (Legal Business Name): JSY ENGLEWOOD FOOT & ANKLE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ENGLE ST STE 202
ENGLEWOOD NJ
07631-2920
US

IV. Provider business mailing address

15 ENGLE ST STE 202
ENGLEWOOD NJ
07631-2920
US

V. Phone/Fax

Practice location:
  • Phone: 201-227-0900
  • Fax: 201-227-0903
Mailing address:
  • Phone: 201-227-0900
  • Fax: 201-227-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: YOON O HAN
Title or Position: OWNER
Credential: DPM
Phone: 201-227-0900